Council Nomination Form



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updated 10.7.08

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Nomination Form

Candidates for Executive Council 2009-2010

Submission deadline is October 17, 2008
Complete and submit online, or print off and fax or mail to:
Tami Sato
Director of Financial Aid
Southern CA College of Optometry
2575 Yorba Linda Blvd.
Fullerton, CA 92831
Phone: (714) 449-7447
FAX: (714) 992-7878
Email: tsato@scco.edu

Nominees are required to provide demographic information as well
as a candidate statement along with a photo
for the web by November 10, 2008 to tsato@scco.edu

Candidate Nomination
Nominee's Name
Nominee's Institution
Street Address
City
State
Zip
Phone
Fax
Email
Optional Questions
Nominee's Gender
Ethnic Origin
Nominate this person for one of the offices below. (from any WASFAA state)
President-Elect Vice President Secretary Representative-at-large for Ethnic Diversity (also chairs the Ethnic Diversity Action Committee) Does this person know his/her name is being submitted? Yes No Has this person's institution agreed to let him/her run? Yes No Why do you believe this person would be a good candidate for this position? Include everything you believe is important for the committee to know.
Nominated By
Institution